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Chronic Disease in VA 13% of Virginians report having fair to poor health in general. Lenowisco, Crater, and Mount Rogers lead all health districts for highest adult current smoking rate (> 29%). The state adult smoking rate is 18%. Cumberland Plateau has the highest percentage of adults reporting smoking allowed in the home (45%). Southside has the highest percentage (45%) of adults living with children who report living in homes where smoking is allowed. The state rates of smoking allowed in the home and smoking allowed in homes where children live are, respectively, 24% and 18%. 25% of employed adults in Virginia report that smoking is allowed in indoor work areas and, therefore, are not protected from secondhand smoke exposure in the workplace. In Southside, Piedmont, and Cumberland Plateau health districts, at least 45% of adults report working in places where smoking indoors is allowed. Two-thirds (62%) of Virginia adults are at an unhealthy weight (i.e., overweight or obese). Crater, Three Rivers, and Eastern Shore lead all health districts with the greatest percentages (>72%) of adults who are overweight or obese. 50% of Virginians do not get enough physical activity. Pittsylvania-Danville, Roanoke City, and Crater health districts lead all health districts for percentage of adults not adequately meeting recommendations for moderate activity. Three-fourths (74%) of Virginians do not meet the daily requirements for eating five or more servings of fruits and vegetables. Southside, Chickahominy, Western Tidewater, and Pittsylvania-Danville lead all health districts with rates above 80%. 18% of Virginians report having a physical, mental, or emotional problem that limits their usual activities. Cumberland Plateau and Lenowisco have the highest percentages of adults reporting activity limitation and are among the top three districts with the highest rates of arthritis (Eastern Shore being the third district). Compared to other health districts, Cumberland Plateau, Alleghany, Crater, and Southside consistently have high rates of hypertension (high blood pressure), high cholesterol, and diabetes, which are all risk factors for cardiovascular disease.

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4 13% of Virginians report having fair to poor health in general. The state adult smoking rate is 18%. Two-thirds (62%) of Virginia adults are at an unhealthy weight (i.e., overweight or obese). Current obesity rate is 30%. 50% of Virginians do not get enough physical activity. Three-fourths (74%) of Virginians do not meet the daily requirements for eating five or more servings of fruits and vegetables. Cumberland Plateau has the highest age-adjusted rate of death from heart disease (213 per 100,000), which is double the state rate (102 per 100,000). Southside has the highest rate of death from cerebrovascular disease (67 per 100,000), which is 60% greater than the state rate (42 per 100,000).

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$ The combined cost of the two diseases is more than $606 billion each year American Diabetes Association. "Economic Costs of Diabetes in the U.S. in 2007". Diabetes Care. Vol. 31, No. 3, pp. 1-20; American Heart Association. "Heart Disease and Stroke Statistics 2010 Update". Circulation. 6

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1 in 3 adults has been diagnosed with cardiovascular disease Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012: published online before print December 15, 2011, 10.1161/CIR.0b013e31823ac046. 10

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Prominent Issues Aging population Increased chronic disease (heart disease, diabetes, cancer and obesity) Age adjusted rate for heart disease is decreasing, but events are happening at an earlier age Dissatisfaction with health insurance, continual rising costs Business impact of ACA VA is not ranked in top 10 states for any of the health indicators – impact on attracting business and maintaining resources Under 19 20 to 44 45 to 64 Over 65 Changes in Virginia’s Population by Major Group (Actual and Projected) 24

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Primary Recommendations All out war on disease – public education on health risks & impact to life support and promotion of health – all ages State support of best practices for employer programs Insurance Reform- “value based” health insurance N Engl J Med 2011;365:2088-97 25